ABSTRACT
The pregnant woman with idiopathic thrombocytopenic purpura (ITP) and her fe-tus-neonate
present a number of challenging issues for both the perinatologist and neonatologist.
A review of these issues within a single format is helpful because of the widely scattered
nature of the pertinent information in the medical literature. Maternal ITP is described
herein as chronic, idiopathic, immune thrombocytopenic purpura, and the multiple interactions
between ITP and pregnancy are detailed. The chief effect of maternal ITP on the fetus-neonate
is thrombocytopenia, which occurs in approximately 37% of infants born to mothers
with ITP. Using available literature, the pathophysiology, natural course, and therapy
for maternal ITP-induced neonatal thrombocytopenia are described. Because affected
infants may be severely thrombocytopenic at birth and at risk for hemorrhagic symptoms
secondary to the stress of vaginal delivery, cesarean section is advocated as the
preferred route of delivery for mothers with ITP. This approach is controversial,
however, principally because many cesarean sections are productive of unaffected or
mildly affected neonates. The predelivery use of fetal blood sampling and the presence
of maternal circulating (unbound) antiplatelet antibody in this setting may provide
the perinatologist guidance as to the appropriate delivery route for the at-risk thrombocytopenic
infant.
